Enhanced Recovery After Gynecological/Oncological Surgeries: Current Status in India
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ORIGINAL ARTICLE
Enhanced Recovery After Gynecological/Oncological Surgeries: Current Status in India Ankit Dhiman1
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M. D. Ray1
Received: 3 September 2020 / Accepted: 12 October 2020 / Published online: 25 November 2020 Ó Association of Gynecologic Oncologists of India 2020
Abstract Purpose With the day-to-day advances in science and technology, perioperative practices are also evolving and include high-quality evidence that improves surgical outcomes. We inspected the perioperative trends in major elective gynecological and oncological surgeries performed by various surgeons practicing in the field of gynecological and oncological surgery in India. Methods A ‘39-questions’ questionnaire was developed on the basis of the recently published ERAS society recommendations for the major gynecological and oncological surgeries using Google FormsÓ and was sent to the various consultants practicing gynecology or surgical oncology across major cancer centers across India. The results of the first 100 responses were noted and analyzed. Results Response rate was 83.3%. 83 surgical and 17 gynecological oncologists participated from 59 different institutions. It was observed that many surgeons were adhering to the latest evidence-based practices like pre- and postoperative education, prehabilitation, DVT prophylaxis, use of MIS, multimodal analgesia, and regular audit. However, there were also some areas where traditional practices were still prevalent which included mechanical bowel preparation, keeping patients fasting overnight, no carbohydrate loading, unnecessarily keeping IP drains and NG tubes for longer times, and refraining from starting orally within 24 h of surgery. Conclusions While most Indian oncological surgeons were adhering to the latest evidence-based practices, they were still lagging behind in certain aspects and traditional practices were being carried forward. With increasing awareness among surgeons, the latest guidelines should be followed for better surgical results. Keywords Evidence-based practices Gynecological/oncological surgery Surgical outcomes Practices
Introduction With the day-to-day advances in science and technology, perioperative practices are also evolving and include highquality evidences that improve surgical outcomes. Enhanced Recovery After Surgery (ERAS) started as a global surgical quality improvement program. The guidelines are most evidence-based and are regularly updated [1]. These include a multi-disciplinary approach and & M. D. Ray [email protected] Ankit Dhiman [email protected] 1
enhance education and training of various health care staff, particularly surgeons [1]. In 2016, the ERAS Society published guidelines for gynecology/oncology surgeries, which were updated in 2019 [2–4]. Various studies assessed the implementation of the latest evidence-based practices in colorectal surgery and found wide disparities in actual practices [5–8]. To the best of our knowledge, none of the investigators have studied the trends of adherence to evidence-ba
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